Department of Mental Health SCVHHS

1. Santa Clara CountyMental Health Services Act PlanningPublic Hearing CSS Three-Year PlanNovember 28, 29, 30, 2005 Department of Mental Health SCVHHS

2. Plan Overview • MHSA Planning Context • CSS State Required Process • Recommended Strategies

3. (MHSA (aka Proposition 63) • 1% tax on taxable personal income over $1 million to be deposited into a Mental Health Services Fund (MHSF) in State Treasury • Administered by State Department of Mental Health • Oversight by 16-Member Accountability Commission • Distributed to Counties Via Current State-County Contract • $300 Est. Million in FY05; $700 Million Est. in FY06 • Is used to expand, not supplant services; can “not be used to supplant existing state or county funds utilized to provide mental health services.” • Phased in approach to implementation, beginning with Planning and Expanded Service components

4. Overview of MHSA Components Six phased-in components completed through a state and local stakeholder involved process: • Community Program Planning (5%) • Community Services and Supports (50%) • Capital and Information Technology (10%) • Education and Training (10%) • Prevention and Early Intervention (20%) • Innovation (5%)

5. State Updates • Accountability Commission Convened • CSS Component Funding Posted: • Santa Clara = $13.4 Million x 3 yrs. • Majority of Counties Posted CSS Plans • Three Plans reviewed by State • Components Pending State Requirements: • Training & Education • Capital and Information Technology • Prevention and Early Intervention

6. Santa Clara County MHSA Planning Structure State Dept. of Mental Health Accountability Commission Board of Supervisors Mental Health Board BOS Committees (HHC, CSFC, PSJC) County Executive SCVHHS Exec. Dir MHSA Stakeholder Leadership Committee Project Management Team Work Group & Strategy Teams Children & Youth 0-15 Years Work Group & Strategy Teams Transition Age Youth 16-25 Years Work Group & Strategy Teams Adults 26-59 Years Work Group & Strategy Teams Older Adults 60+ Years Ethnic Community Advisory Committees Ethnic Community Advisory Committees Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups Focus Group Focus Group Focus Group Focus Group Focus Group Cultural Competency Wellness and Recovery Evidenced Based Practices MHSA Vision & Requirements

7. Plan Requirements The Three-Year CSS Plan 1 2 3 4 Identify Specific Populations for Focus Identify Community Concerns for All Ages Determine Unmet Need Identify strategies to Meet Need

8. CSS –Funding for Three Types of Service • Full Service Partnership Funds(51+% ) – to provide “whatever it takes” in necessary services and supports for new clients of focal populations (treatment, housing, self-help, vocational support) • General “Capacity Building” Funds – to improve services and infrastructure; can be system-wide strategies • Outreach and Engagement Funds – to engage those underserved populations that are currently receiving little or no service

9. Essential Elements of all County plans: • Community collaboration with system partners, general community, consumers and families • Cultural competence throughout system • Client/family driven mental health system for older adults, adults and transition age youth and family driven system of care for children and youth • Wellness focus, which includes the concepts of recovery and resilience, self-help, consumer-directed service • Integrated service experiences for clients and their families throughout their interactions with the mental health system

10. Local MHSA Planning Work to Date • Major Inreach and Outreach Campaign regarding Critical Concerns and needs from March through June –10,000 voices have been heard through meetings and surveys! • Stakeholder Leadership Committee convened andendorsed critical concerns, focal populations & draft plan recommendations from Work Groups, Strategy Teams, and Ethnic Community Advisory Teams

11. Focal PopulationsDefined Per Requirements • Children • Zero to Five Years High Risk • Foster Care Youth • Juvenile Justice Involved Youth • Underserved Seriously Emotionally Disturbed • Transition Age Youth • Sixteen to 25 Years Aging Out of Systems • First Time Psychosis

12. Focal PopulationsDefined Per Requirements • Adults • Homeless, Dual Diagnosed, Jailed • Frequent ER User Seriously Mentally Ill • Underserved/Unserved SMI • Jail Involved Dual Diagnosis Non SMI • Older Adults • High Risk Seriously Mentally Ill • Isolated/Homebound Mentally Ill

13. Overview of Recommendations

14. Children 0-15 • C-01 Full Service Partnerships– 30 slots; est. $20K per year per child, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian juvenile justice involved and youth without insurance. • C-02 Zero to Five System Development – to develop inter-agency infrastructure to support 0-5 year olds, includes planning; screening/assessment design; training of specialists; family support and system navigation for monolingual Latino and Vietnamese families.

15. Children 0-15 • C-03 Behavioral Health System Development– System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of juvenile justice and foster care populations. Emphasis on underserved Latino, Asian, African American, Native American youth and families.

16. Transition Age Youth 15 – 25 Years • T-01 Full Service Partnerships– 30 slots; est. $20K per year per youth, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian exiting juvenile justice and foster care systems. • T-02 Behavioral Health System Development– System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of youth child-serving systems. Emphasis on underserved Latino, Asian, African American, Native American youth and families.

17. Transition Age Youth 15 – 25 Years • T-03 Crisis & Drop-In Services and Supports– safe, non-stigmatizing access to mental health and basic services. • T-04 Education Partnership – Integrated “middle college” and community college support to improve “school success” of youth with mental health concerns.

18. Adults 26-59 • A-01 Full Service Partnerships– 75 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, Asian and American Indian, homeless, institutionalized, and frequent ER users with severe mental illness. • A-02 Behavioral Health Recovery Services– to redesign county adult outpatient services to include consumer and family support staff; add support and case management staff; and to introduce best practice strategies and align and establish therapeutic caseload size.

19. Adults 26-59 • A-03 Jail Aftercare and Recovery Services– for criminal justice involved mentally ill: • Full Service Partnerships - 75 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian; • Enhanced Treatment Court – 60 slots for case management and service linkage; • Dual-Diagnosis After Care Treatment – 125 slots for medication and case management services; • Expanded Housing Options – 75 beds; Transitional Housing Units (THU)

20. Adults 26-59 • A-04 Adult Urgent Care and Crisis Support– Establishes urgent care and mobile crisis response in north, central and south county regions. • A-05 Consumer and Family Self-Help Support– Establishes Director of Consumer Affairs and Director of Family Support and Education, in addition to expanded consumer and family self-help with focus on unserved and underserved ethnic and cultural communities.

21. Older Adults 60+ • OA-01 Full Service Partnerships– 25 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on those in or at risk of homelessness, institutionalization, incarceration; physical and emotional harm. • OA-02 Behavioral Health Services– System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of older adults; expanded service to senior day programs.

22. Older Adults 60+ • OA-03 Senior Mobile Assessment & Outreach– Provides specialized mobile assessment and outreach services to shut-in and homebound mentally ill seniors, many of whom are experiencing concurrent medical and substance abuse problems; focus on monolingual seniors. • OA-04 Senior Family and Caregiver Support– Provides culturally appropriate family and caregiver support and education to those caring for mentally ill seniors.

23. Support Staff • 2.0 Full Service Coordinators • 1.0 Training Director • 2.0 Q.I./U.M. Coordinators • 1.0 Utilization Management Analyst • 1.0 Cultural Competency Coordinator

24. Crosscutting Strategies • State requirements allow up to 6 months ($6.7 million) of FY06 funds to be used for one-time expenses over three years. These funds are proposed to support several age-based plans in addition several cross-cutting initiatives.

25. Crosscutting Strategies • HO-01 – Housing Options - establishes $2 million fund to develop housing options in collaboration with key leaders in housing support and resource development. These resources, combined with housing support resources in FSP, and other housing options, will insure that 25-30% of available CSS funds during initial 3-years is committed to facilitate permanent stable living for those served. Further capital housing resource is anticipated through Capital and Technology.

26. Crosscutting Strategies • FH-01 – Community & Family Outreach and Engagement Initiative –to develop culturally competent outreach and engagement strategies to underserved populations. • HC-01 – Behavioral & Primary Health Care Partnership – to establish integrated pilot primary care services for clients of the mental health system.

27. Crosscutting Strategies • EE-01 – Education, Employment, and Self-Sufficiency Services - to develop comprehensive education, employment and benefit assistance system for all clients of the system. • ST-01 – Regional Survivors of Torture Treatment Services – to establish regionally available specialty treatment services for Bay Area refugee survivors of torture.

28. FY09 and Beyond • Following initial Three-Year Plan County will submit renewal plan • Increased revenues expected in future years to finance one-time initiatives and expand strategies to further populations • MHD may revise strategies depending on outcomes achieved with DMH approval

29. Next Steps • December 5th–Proposed Plan to MHB • December 7th - Proposed Plan to HHC • December 13th– Proposed Plan to BOS • December 30th–Final Plan to State DMH • January – April –Implementation Readiness • April - June– Implementation of Programs

30. Contact Info Nancy Pena, Ph.D., Director, MHD, 408-885-5783 Bruce Copley, Deputy Director, MHD 408-885-5773 Tiffany Ho, M.D., Medical Director, MHD, 408-885-5781 Sheila Yuter, MHSA Coordinator, 408-885-3885 Maria Fuentes, Ethnic Services Manager, 408-885-5775 Santa Clara County MHD Website www.sccmhd.org State Dept. Mental Health website www.dmh.ca.gov